The intervertebral discs are gel filled structures in the spine that act as cushion in between the vertebral bones. Degenerative disc disease (DDD) is a common condition that results from wear and tear of the intervertebral discs. As we age, the discs deteriorate due to repetitive stress, increased load, and decrease in blood flow and nutrition to the discs. Degenerative changes in the discs include: annular tear (tear in the outer fibrous ring of the disc), herniation or bulge, decrease in height, drying out, stiffness and bone spurs.
Symptoms of Degenerative Disc Disease
The symptoms of degenerative disc disease are dependent on the disc that is involved and changes in the surrounding spinal structures as a result of, or associated with the degeneration. The most common symptom of degenerative disc disease is a continuous deep pain in the neck, midback or low back that occasionally flares up to a more intense, disabling pain. The episodes can last for a few days or several weeks, and typically recurs. The baseline pain is variable in individuals and can range from almost no pain, nagging ache or severe pain.
The pain typically gets worse with prolonged sitting, standing and walking. Twisting and bending the spine, or carrying heavy loads can also aggravate the pain in the back. Prolonged tilting of the head down while reading or working on the computer can worsen neck pain.
The pain can refer to the buttocks and hips when the lumbar spine is involved, or to the shoulder blade region when the cervical spine is involved. When the degenerated disc compresses or irritates the nearby spinal nerves, radiating pain can be felt in the buttocks, hips, legs and feet (lumbar disc degeneration); or in the shoudler, arm and hand (cervical disc degeneration). Individuals with disc problems can also experience muscle tightness or muscle spasms.
It is not uncommon to see degenerative changes in the spinal imaging of patients over 60 years old. Majority of these patients will not present with symptoms.These imaging findings must be interpreted in the context of the patient’s clinical condition.
Treatment Options for Degenerative Disc Disease
Nonsurgical Treatments Options
Majority of patients who develop symptoms from degenerative disc disease respond well to conservative treatments without the need for surgical intervention.
- Medications: Non-steroidal anti-inflammatory medications (NSAIDS) decrease the symptoms of pain and inflammation associated with this condition. Analgesic medications or muscle relaxants can be helpful when the symptoms are severe. Medications to decrease nerve-related pain, called “sciatica” in the lumbar spine, can also be beneficial.
- Physical Therapy: Therapeutic exercises to strengthen the supporting muscles, improve spinal alignment, flexibility and stability, are critical in healing the spine. A physical therapist can help teach proper exercises and educate on activity modifications to help prevent recurrence of symptoms and injuries.
- Regenerative Treatments: These are innovative, non-surgical treatments using cells from your own body to heal and repair orthopedic conditions. These cell therapies, called Platelet-rich plasma and Cell-based Therapies derived from Bone Marrow, have been shown to help treat spinal conditions and provide long-term relief.
Surgical Treatment Options
Surgery is an option when all conservative treatment options have failed, when there is severe, debilitating pain that interferes with daily function, or when there is worsening neurologic function. These surgeries may involve the removal of a bulging portion of the disc (discectomy), removal of a portion of the bone in the spinal canal (laminectomy), replacing the degenerated disc with an artificial disc, or spinal fusion.
For help with your back pain and degenerative disc disease, please contact the experts at San Diego Orthobiologics Medical Center.
The human spine is composed of 24 individual bones called the vertebrae. In between these bones are the intervertebral discs, which are gel filled structures that act as shock absorbers. They consist of a tough outer layer called the annulus fibrosus that protects the disc’s gel-like interior, the nucleus pulposus. In the lower back, the discs are a little more than a third of an inch (10 millimeters) thick and about 1.5 inches (four centimeters) in diameter.[i]
A bulging disc or herniated disc occurs when the outer layer of the disc weakens and tears. This can cause the inner gel to bulge out to the spinal canal and affect the nearby nerves causing back pain, leg pain or muscle spasm. The disc tear can also cause leakage of materials into the spinal canal that can cause inflammation and pain.
Herniated discs most often occur in the lower back but can occur anywhere in the spine, including the neck and the midback. The location of the herniated disc often determines where the patient will feel symptoms of pain, tingling, numbness or weakness. Bulging discs in the lumbar spine can result in pain in the low back, buttocks, thighs, legs and feet. On the other hand, if your herniated disc is in the cervical spine, pain can be felt in the neck, shoulders, arms and hands.
What Causes a Herniated Disc?
Disc herniation can occur due to injury or age-related wear and tear. As people age, the disc nucleus pulposus loses hydration, wears down and leads to degeneration. Other factors may increase the risk of developing a herniated disc. These include:
- Repetitive lifting, pulling, pushing, bending and twisting
- Increased height (tall people)
- Smoking (decreases blood supply to the disk leading to degeneration)
A thorough medical history and physical examination can lead to the diagnoses of disc herniation. An MRI of the spine is an imaging modality that reveals herniated discs and other structural abnormalities of the spine.
The treatment for most cases of mild to moderate herniated discs involves conservative measures which include the following:
- Activity modification: Avoid repetitive twisting, bending or lifting. Do not sit or stand for extended periods of time.
- Physical therapy to strengthen your trunk, arm and leg muscles that support the spine.
- Medications: Anti-inflammatory medications such as ibuprofen or naproxen, muscle relaxers, or pain killers
- Ice packs or heating pads
- Alternative therapies such as acupuncture, massage or gentle chiropractic manual therapies to manage pain.
When conservative measures fail to provide symptomatic relief, a board-certified spine specialist can offer injection treatments that do not require hospitalization and provide a more rapid recovery than surgery.
Epidural corticosteroid injection is a treatment that delivers steroid, a powerful anti-inflammatory medication, directly to the source of pain. This is performed using fluoroscopic (x-ray) guidance. This treatment can provide immediate relief of pain. The number of treatments is limited as repetitive steroid use could result to tissue damage, hormonal irregularities, osteoporosis and decreased immune response.
Cell-based therapies can treat disc degeneration and tears that are traditionally managed with medications or surgery. These treatments have been shown to increase disc hydration and disc cell proliferation, decrease inflammation, increase disc support tissue and assist in tissue healing. These therapies involve obtaining the patient’s own healthy cells and delivering them to the injured disc where they can jump start the body’s own regenerative healing processes.
- Platelet Rich Plasma uses platelets in the blood that release growth factors and proteins to promote tissue repair, while the plasma carries the hormones, electrolytes and nutrients required to nourish cells during the healing process.
- Cell Based Therapies use cells derived from the patient’s own bone marrow. Bone marrow contain adult stem cells that have the unique ability to develop into the specific kind of cells, including anulus and nucleus pulposus cells. They also contain many other healing cells and molecules that direct other cells in the area to form new blood vessels, awaken stem cells and produce collagen or other proteins essential for creating healthy new tissue.
Patients considering regenerative treatments such as these cell therapies need to know that the U.S. Food and Drug Administration (FDA) does not currently allow the use of stem cells derived from birth tissue products such as amniotic fluid or umbilical cord blood to treat orthopedic conditions. These donor products do not contain live stem cells and have not been tested for safety or efficacy.
Candidates for Cell-Based Therapies for Herniated Discs
The success of cell-based treatments for herniated discs is dependent upon the severity of your condition and your overall health. Cell-based treatments are not suitable for those who have active cancer, infection, history of blood disease, or are pregnant.
Cell-based therapies are giving new hope for long-lasting pain relief to many patients with injured discs. It is important that you take an active role in your healing and recovery with good nutrition and a commitment to overall fitness to achieve the best outcome.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with interventional spine procedures and cell-based treatments for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same- day treatments with the highest level of safety and efficacy.